Short Scar Research Articles

Restoration of Hip Geometry after Femoral Neck Fracture: A Comparison of the Femoral Neck System (FNS) and the Dynamic Hip Screw (DHS).

The femoral neck system (FNS) was introduced as a minimally invasive fixation device for managing femoral neck fractures. To compare radiographic, clinical, and patient-reported outcome measures (PROMs) of femoral neck fracture patients following FNS compared to dynamic hip screw (DHS) implantation combined with an anti-rotational screw. Patients who underwent closed reduction and internal fixation of a femoral neck fracture between 2020 and 2022 were retrospectively included. We measured leg length, femoral offset, and centrum-collum-diaphyseal (CCD) angle in plain radiographs. Scar length, Harris Hip Score, short-form health survey 36-item score (SF-36), and Numeric Rating Scale (NRS) were assessed during follow-up visits. We included 43 patients (22 females) with a median age of 66 (IQR 57, 75). In both groups, leg length differences between the injured and the contralateral side increased, and femoral offset and CCD angle differences were maintained over time. FNS patients had shorter scars and reported fewer emotional problems and more energy. There were no differences between groups regarding the remaining SF-36 sub-scores, Harris Hip Score, and NRS. The FNS allows for a comparable leg length, femoral offset, and CCD angle reconstruction while achieving similarly high functional and global health scores to the DHS.

Patient and Clinician Reported Outcomes of the Inframammary Incision "Short Scar Technique" in Primary Breast Augmentation.

Breast augmentation is a common aesthetic surgery procedure and surgeons are constantly trying to develop techniques that help improve patients' outcome. One of the most important aspects is achieving a favorable scar. The "traditional" breast augmentation scar is in the inframammary fold (IMF), whereas trans-axillary and trans-umbilical approaches have been described as an attempt to move the "location" of the scar and make it less noticeable. Nonetheless, relatively little attention has been paid to improving the IMF scar, which remains the most commonly used scar for silicone implants. The authors have previously described a technique that uses an insertion sleeve and custom-made retractors to allow implant insertion through a shorter IMF scar. However, at the time, the authors did not evaluate the quality of the scar and patient satisfaction. In this manuscript, the authors describe patient and clinician-reported outcomes for this short scar technique. All consecutive female patients, undergoing primary aesthetic breast augmentation with symmetric implants were included in this review. Three different scar-assessment scales demonstrated good results at 1-year postop, as well as the good correlation between patient-reported and clinician-observed scores. BREAST-Q subscale for overall satisfaction also demonstrated good overall patient satisfaction. Besides providing an added aesthetic value to the result of breast augmentation, a shorter scar may also appeal to patients who are concerned about the size and quality of postoperative scars and like to search for "before and after" pictures prior to scheduling consultations.

Keller Funnel Efficacy in "No Touch" Breast Augmentation and Reconstruction: A Systematic Review.

A systematic review of PubMed, Embase, the Cochrane database, and Google Scholar was performed between 2005 and 2021. All clinical-based, retrospective and prospective studies utilizing the Keller funnel method for breast implant insertion were selected. Six studies were identified for evaluation: five were retrospective cohorts and one was a prospective trial. No randomized controlled trials were found. Outcomes reported included lower rates of capsular contracture (RR, 0.42; P = 0.0006; 95% CI, 0.25-0.69), shorter incision lengths (35.5 ± 2.1 mm), less insertion time (mean = 6 seconds), and decreased complications, and one paper reported ultimately greater patient satisfaction with outcomes (BREAST-Q Score: 92%). This review suggests that the Keller funnel is a useful method for no-touch breast augmentation and reconstruction surgery. The Keller funnel reduces subsequent capsular contracture rate, surgical time, and incision length and allows for easier insertion. However, our findings support recommendation of a prospective randomized controlled clinical trial with larger population size and follow-up intervals.

Short- and long-term outcomes as well as anal function of transanal natural orifice specimen extraction surgery versus conventional laparoscopic surgery for sigmoid colon or rectal cancer resection: a retrospective study with over 5-year follow-up.

IntroductionTo date, long-term safety including functional outcomes of transanal natural orifice specimen extraction surgery (NOSES) for colorectal cancer resection has not been confirmed.AimTo explore the short- and long-term outcomes as well as anal function of transanal NOSES versus conventional laparoscopic surgery for sigmoid colon or rectal cancer resection.Material and methodsA retrospective review of data from a prospectively maintained database was performed to analyze the data of 69 patients who underwent transanal NOSES for sigmoid colon or rectal cancer resections and another 69 matched patients who underwent conventional laparoscopic (CL) surgery. Anal function of patients was evaluated using the Wexner fecal incontinence scale postoperatively.ResultsTransanal NOSES resulted in faster recovery of intestinal function, shorter postoperative length of stay, less incisional pain, fewer postoperative complications and shorter scars than CL surgery (p < 0.05). The two groups had similar overall survival (p = 0.863) and disease-free survival (p = 0.961). Wexner scores of the NOSES group at 1, 3 and 6 months after surgery were higher than in the CL group (p < 0.05), and there was no difference between the two groups at 12, 18 and 24 months after surgery.ConclusionsTransanal NOSES achieves similar survival outcomes to CL surgery. Transanal NOSES has the advantages of faster recovery, shorter postoperative hospital stay, less incisional pain, shorter scars, etc. However, transanal NOSES can indeed impair anal function, needing more attention.

The "Arrow Flap" Technique in Reduction Mammaplasty: Combining Short Scars, Narrow Base, and High and Persistent Breast Projection.

Breast reduction is one of the most common procedures performed by plastic surgeons worldwide. Despite that several techniques have been proposed for management of ptotic or hypertrophic breasts, most of them often deal with too large breast bases, poor breast projection, persistent "dog ears," and a certain percentage of bottoming out. Lower-pole shaping of the breast remains one of the challenge of vertical mammoplasty. The authors report their 5-year-long experience with a modification of the vertical scar technique, the "arrow flap," in which they harvest a double lateral glandular and cutaneous flap, to tighten and better shape the base of the breast and to improve the breast projection with a "double-bra" effect. From April 2015 to February 2019, 75 patients with moderate to severe macromastia/breast ptosis underwent bilateral reduction mammoplasty. Postoperative outcomes showed an overall satisfactory results and low incidence of complications. Two patients presented with an asymmetry between the 2 breasts, and no nipple-areola complex necrosis occurred. One patient reported a wider vertical scar, whereas no bottoming out was observed. All patients reported a stable and durable projection of the breast, with pleasant cosmetic results. By combining short scars and narrow base, we can obtain a pleasant lower pole reshaping of the breast, even in that challenging cases of large and squared breast. The authors believe that this technique provides a useful surgical option, increasing the versatility of the superior pedicle vertical mammaplasty both for mastopexy and breast reduction, even in cases of severe macromastia.

Extra-Articular Arthroscopic Excision of the Intramuscular Hemangioma in a Lower Extremity Has Better Therapeutic Effect and Higher Satisfaction with Appearance Comparing with Open Excision

Intramuscular hemangioma is a rare but challenging cause of pain in the lower extremities. When nonsurgical approaches have a certain possibility of post-procedural recurrence or incomplete success, surgery is a good choice. An open excision forms a long scar but allows for a wider surgical scope. Excision by arthroscopy may be a possible method for the treatment of intramuscular hemangioma with overall better results. The purpose of this study was to evaluate and compare the clinical outcomes of arthroscopic and open excisions for the treatment of intramuscular hemangioma of a lower extremity. Fifty-two patients with intramuscular hemangioma were divided into either the arthroscopic or open excision groups. Each group was compared by operative time, Lysholm score, length of the scar, the numbness of the surgery area, satisfaction of appearance, recurrence, and infection. Compared with the open excision group, the Lysholm scores mean ± standard error between the arthroscopic and open excision groups were 96.2 ± 3.7 to 93.2 ± 4.2 (P < 0 .05), the scar lengths were 0.61 ± 0.17 cm to 10.04 ± 5.31 cm (P < 0.01), numbness scores were 1.08 ± 0.74 to 2.19 ± 1.02 (P < 0.01), and satisfaction with appearance scores were 8.42 ± 1.27 to 5.27 ± 1.48 (P < 0.01). The clinical results were comparable between the arthroscopic and open excision groups, suggesting that an arthroscopic excision on the intramuscular hemangioma can achieve better function, a shorter scar, and a higher satisfaction with appearance.

Short or Minimum Incision Deep Plane/Extended Deep Plane Facelift/Rhytidectomy.

The mini facelift, often referred to as short scar or minimum incision facelift or rhytidectomy, is a facial rejuvenation procedure with limited incisions. It aims to lift and tighten the superficial musculo-aponeurotic system to restore the lower midface and the mandibular contour, thus eliminating undesirable jowls. By performing the deep plane or extended deep plane facelift with short incisions, the midface and upper neck can also be improved without the full face and neck incisions as in the typical rhytidectomy. With its decreased operative time and expense, rapid recovery, less complications, as well as more limited incisions with resultant less evidence of scars, mini facelift techniques have boomed over a decade for younger patients who seek facial rejuvenation. We describe our concept of the short or minimum incision deep plane/extended deep plane facelift or rhytidectomy and address what results can be expected.

Reconstruction of complex shallow defects of the extremities with musculofascial serratus anterior free flap

Background/aim Thin and flexible flaps are needed for the repair of extremity tissue defects. Serratus fascia flaps are the most suitable options. There are only a few case reports and case series in the literature. We have aimed to increase the success rate by taking the serratus fascia flaps together with some muscle tissue for the repair of extremity tissue defects. Materials and methodsBetween 2006 and 2015, 12 free serratus musculofascial flaps (FSMFFs) were transferred to 11 patients (8 males, 3 females) who had tissue shallow defects of the extremities due to different etiologic factors. The mean age was 24.6 years. Hospital records and patient photographs were reviewed and age, sex, etiologic cause, follow-up period, complication, flap success, cosmetic appearance, and functional results of the extremity were examined.Results The mean follow-up period was 29.5 months (7–109 months). All of the flaps survived fully and no partial or full necrosis was observed. Partial graft loss was encountered in one patient and it was recovered secondarily with wound dressing. A major deficiency was not experienced postoperatively in the functions and movements of the extremities retained. The cosmetic appearance of the operation area was acceptable or fine. The donor areas healed in all the patients without any problems, and the scars were hidden and inconspicuous.Conclusion In reconstruction of complex shallow defects of the extremities in which a gliding effect is desired, FSMFF may be an ideal option with its advantages as it does not sacrifice a major vessel, does not leave a hidden and short scar, can be harvested in wide dimensions, and allows the use of the surrounding tissues such as the latissimus dorsi muscle and scapular bone.

THE USE OF CAD/CAM TECHNOLOGY IN SURGICAL TREATMENT OF CONDYLAR HEAD FRACTURE

&#x0D; &#x0D; &#x0D; Management of the condylar head fractures is still one of the most controversial issues of the maxillofacial surgery. The aim of the present study was to increase the accuracy and quality of the surgical treatment of condylar head fracture with the use of navigation sur- gical guide and patient specific reinforcement two-component plate and individualized fixator with the use of CAD/CAM technology. In study was included 8 patient with 10 condylar head fractured. In 5 cases was used navigation guides, in 4 cases (the biomechanical unfavorable) was used the patient specific two-component plate and only in one case we used individualized patient specific plate. A CT scan was done immediately after the operation. The reduction of the fragments and the location of the screws, plate and fixator were checked on the same view in the preoperative and postoperative pictures on the computer. The relation between the screw and the cortical bones was clearly shown on CT, and the sizes of the bicortical screws were suitable with no injury to the articular cartilage or surrounding tissue. The three-dimensional objects showed that the screw was in the designated position and the condyle had been replaced and fixed in the normal position. The height of the ramus on the fractured side was restored imme- diately postoperatively. The malocclusion was corrected and the passive mouth opening of each patient was never less than 3 cm. One patients had transient paralysis of the temporal branch of the facial nerve postoperatively, which gradually recovered within a 2 month. Postoperative clinical examination showed good occlusion and mouth opening of at least 3 cm in all patients after 3 months without pain. All patients regained normal mandibular movements and had short and invisible scars at 6 months’ follow-up. Given the small number of patients, this issue needs further study in randomized prospective studies involving more patients and evaluating long-term postoperative outcomes.&#x0D; &#x0D; &#x0D;

The Pectoralis Major Island Flap: Short Scar Modified Muscle-Sparing Harvesting Technique Improves Aesthetic Outcome in Reconstructive Head and Neck Surgery

Background: Pectoralis major flap reconstruction is often associated with large unappealing scars in head-neck surgery. We recently established an alternative harvesting technique that improves aesthetic outcome. Objectives: The objective of this study was to demonstrate a modified surgical technique that harvests the pectoralis major muscle as an island flap and focuses on minimizing incision lines and applying a muscle-sparing approach. Methods: A retrospective analysis covering the period 2008–2018 was conducted. Patients who underwent pectoralis major island flap reconstruction for fistula prophylaxis after salvage laryngectomy at the Medical University of Innsbruck were included. Flap harvesting was performed subcutaneously using two small incision lines, thereby sparing the clavicular and upper sternocostal aspects of the pectoralis muscle. Results: Twenty-three patients with squamous cell carcinoma of the larynx (n = 19) or pharynx (n = 4) underwent salvage laryngectomy and consecutive reconstruction using a pectoralis major island flap and our muscle-sparing technique. Mean overall operation time was 147 ± 48.6 min. The majority (70%) of patients had an uneventful course of recovery and showed satisfying aesthetic results and low donor site morbidity as compared to traditional harvesting techniques. Six (26%) patients had major complications that required surgical revision. Three (13%) cases were complicated with fistulas. Conclusion: The pectoralis major island flap is shown to be reliable in otolaryngeal surgery. This surgical technique minimizes scarring and preserves thoracic wall architecture by taking a less invasive approach, thereby improving aesthetic outcome and reducing overall patient morbidity.

Optimizing the Aesthetic Outcome of Short Scar Periareolar Inferior Pedicle Reduction Mammaplasty

The inferior pedicle is still the most commonpedicle used for breast reduction using both inverted T andvertical closure, however many unfavorable results may followas bottoming out and decreased upper pole fullness. Manytechniques were done to overcome the drawbacks of theinferior pedicle technique.Patients and Methods: 10 patients complain of huge ptoticbreast had inferior pedicle technique with full release ofpedicle from skin with glandular brassiere support in form oflower pillars on both sides with vertical skin closure.Results: Satisfactory long term results both objectivelyand subjectively, with good upper pole fullness and withoutbottoming out and only with vertical scar.Conclusion: This technique combined both the merits ofthe inferior pedicle reliability and better aesthetic results.

Surgical approach for open reduction and internal fixation of clavicle fractures: a comparison of vertical and horizontal incisions

This study was designed to compare the results of clavicle fracture open reduction internal fixation (ORIF) with standard horizontal incision versus vertical incision. ORIF surgery performed between October 2012 and August 2016 was included. The surgical approach was chosen according to surgeon preference as vertical or horizontal. Functional outcomes, fracture union, complications, scar appearance, skin irritation, and denervation around the scar were assessed at a minimum follow-up of three months. Thirty-eight patients, age 39 ± 12years, were operatedupon, 22 through vertical incisions and 16 through horizontal incisions. There were no significant group differences in functional scores, fracture union, or complications. Two patients in the vertical incision group had a post-operative haematoma. The scar length was significantly shorter when a vertical incision was used (6.75 ± 1.25cm vs 8.9 ± 2.3cm, P = 0.001). The typical distribution of hypoesthetic skin area distal and lateral to the scar represented iatrogenic damage to the supraclavicular nerves and was found in 66% of patients. The mean hypoesthetic surface area was smaller in the vertical incision group (38 ± 29cm2 vs 48 ± 28cm2, P = non-significant). Vertical incision results in shorter scars but may be associated with increased incidence of haematomas. Meticulous closure of the subcutaneous tissue is recommended.

Protocols for C-Brick DNA Standard Assembly Using Cpf1.

CRISPR-associated protein Cpf1 cleaves double-stranded DNA under the guidance of CRISPR RNA (crRNA), generating sticky ends. Because of this characteristic, Cpf1 has been used for the establishment of a DNA assembly standard called C-Brick, which has the advantage of long recognition sites and short scars. On a standard C-Brick vector, there are four Cpf1 recognition sites - the prefix (T1 and T2 sites) and the suffix (T3 and T4 sites) - flanking biological DNA parts. The cleavage of T2 and T3 sites produces complementary sticky ends, which allow for the assembly of DNA parts with T2 and T3 sites. Meanwhile, a short "GGATCC" scar is generated between parts after assembly. As the newly formed plasmid once again contains the four Cpf1 cleavage sites, the method allows for the iterative assembly of DNA parts, which is similar to those of BioBrick and BglBrick standards. A procedure outlining the use of the C-Brick standard to assemble DNA parts is described here. The C-Brick standard can be widely used by scientists, graduate and undergraduate students, and even amateurs.

Vertical mammaplasty with purse string suture for correction of breast ptosis

Objective To evaluate an improved technique of vertical mammaplasty with purse string suture for correction of breast ptosis and its clinical application. Methods The adjustable markings of vertical mammaplasty was improved with an upper pedicle for the areola, and breast reduction was adapted with the lower part. The breast tissue was lifted and fixed on the second rib level to reshape the breast, which did not rely on the skin, with purse string suture for the lower half of vertical incision. 32 patients with breast ptosis had been operated from May 2009 to February 2014. Results 32 cases were treated with vertical mammaplasty with short scar. The shape of the breasts was strengthen, without obvious scar, and follow-up results of patients were satisfied. Conclusions The vertical mammaplasty with short scar design is simple, operation is convenient, breast shape is plump, and postoperative long-term effect is great. This procedure can be used as one of the feasible operation for breast ptosis correction. Key words: Breast ptosis; Mammaplasty; Purse string suture; Scar

SPAIR technique in oncoplastic breast surgery: The first case series

Introduction: Therapeutic mammoplasty combines plastic surgical techniques with oncological breast cancer resection to obtain optimal margins and acceptable aesthetic outcomes despite larger tumour-to-breast volume ratios. The Short scar Periareolar Inferior Pedicle Reduction(SPAIR) technique was described by Hammond in 1998. It combines avoidance of T junction scarring with a secure inferior pedicle. This is the first series reporting its application in oncoplastic breast surgery.

Breast reduction: personal technique.

Macromastia is a health problem that requires the coordination of surgical and medical specialists. Goals of reduction mammaplasty are to alleviate physical, emotional and psychosocial discomforts and to restore a conical-shaped breast, maintaining scars as short as possible. We report our approach for reduction mammaplasty with superior pedicle. Our method combines advantages of round block with vertical scar, using a dermal flap that is fixed to the new mammary crease. We analyzed skin and glandular resection customizing the mammaplasty. The dermal flap works against the weight of residual tissue, maintaining the crease at the desired position with a natural result. Benefits are an excellent projection, short scar, suitable reshaping and patient satisfaction. This technique can be used for mild to severe hypertrophy with various degrees of ptosis. It results in a successful aesthetic outcome with minimal scarring, suitable breast remodeling and natural long-lasting projection.

Minimally invasive semitendinosus tendon harvesting from the popliteal fossa versus conventional hamstring tendon harvesting for ACL reconstruction: A prospective, randomised controlled trial in 100 patients

BackgroundThis study aims to compare a technique for hamstring tendon harvesting from a postero-medial incision in the popliteal fossa with the conventional method. MethodsOne hundred patients who underwent anterior cruciate ligament (ACL)-reconstruction were randomised to either have their tendon graft harvested from postero-medial (group 1) or via an antero-medial approach (group 2). Time for tendon harvest, length of skin incision and duration of tendon harvest were recorded as well as complications and sensory disturbances in the lower leg. Pain scores were documented on the VAS scale. ResultsTime for tendon harvesting averaged one minute 23 s in group 1 versus five minutes 20 s in group 2 (p<0.01). The skin incision measured 21 mm (group 1) versus 49 mm in group 2 (p<0.01). The length of the harvested tendon averaged 272 mm (group 1) and 292 mm in group 2 (p<0.01). There was one superficial wound infection in group 2 and none in group 1. Postoperative pain scores were similar in both groups. None of the patients in group 1 reported sensory disturbance in the lower leg, whilst seven patients in group 2 were found to have reduced sensation in the distribution of the saphenous nerve postoperatively (p<0.01). ConclusionThis study confirms that harvesting the semitendinosus tendon from postero-medial is quicker, results in a shorter scar and reduces the risk of injury to branches of the saphenous nerve. However, harvesting the tendon from postero-medial resulted in a shorter tendon graft. Level of EvidenceLevel I (Randomised, controlled trial)

Cosmetic outcomes and patients' satisfaction of oncoplastic surgery in Korean patient with breast cancer

Purpose: Oncoplastic surgery (OPS) has emerged as the latest ideal surgery in treatment of breast cancer. The purpose of this study is to evaluate the cosmetic outcome of volume displacement surgery and patients’ satisfaction in Korean women with relatively small breast size. Methods: This is a retrospective study of 173 patients who had volume displacement of OPS between January 2008 and December 2013. Cosmetic outcome was evaluated by patients’ questionnaire and a doctor. The patients’ satisfaction was assessed by a questionnaire divided into four categories; cosmetic satisfaction, satisfaction on operative method, femininity, and side effects. Relationship between removed specimen volume and patients’ satisfaction was also analyzed. Results: About 90% of patients answered above the fair in cosmetic items and operative methods, only less than 5% of all patients reported of severe complications such as cramps or limitations of exercise. The patients’ cosmetic satisfaction score were significantly inversely related with removed specimen volume and doctor’s cosmetic assessment was also accordance with this result (P<0.05). Most patients preferred good contour over short scar regardless of age and marital status (good contour 54% vs. short scar 21%). Conclusion: Volume displacement of OPS brings both the best possible cosmetic outcome and high patient satisfaction for Korean women with a small size of breast in breast cancer surgery. It is highly suggestive that Korean women considers good contour more than the size of scar; therefore, volume displacement of OPS is a recommendable means of breast cancer surgery for Korean women. Keywords: Breast, Neoplasms, Cosmetics, Mammaplasty

Hatchet Flap: Clinical Evaluation of Results in Reconstruction of Lateral Nasal Region Defects.

Hatchet rotation-advancement flap is a well-known flap design, which is a worthwhile option in the reconstruction of lateral nasal region skin defects. In this study, the author's experience with 3 different designs of hatchet flaps, for the reconstruction of the defects in 3 different parts of the lateral nasal region, has been presented. All flaps in 31 clinical cases were planned from the cheek and nasolabial region. For the defects in the upper 1/3 part, flaps were planned in advancement type, for the middle 1/3 part, flaps were planned in rotation-advancement type, and for the lower 1/3 part, flaps were planned in rotation type. Satisfactory results were achieved in all patients except in patients having defects in the lower 1/3 part. In reconstruction of lateral nasal region defects, hatchet flap has different advantages such as versatility, better tissue match, and short final scar in the nasolabial fold. When planned in rotation type, for the lower 1/3 part, the ratio of complications increases significantly, which necessitates considering other flap options as the first-line choice of reconstruction for this region.

Short-scar facelift without temporal flap: a 10-year experience.

The understanding of facial anatomy and its changes through aging has led to the development of several different facelift techniques that focus on being less invasive and traumatic and, at the same time, providing natural long-lasting results. In this article we describe step by step our facelift technique as it has been done over the past 10 years by the senior author. This is a retrospective, descriptive, transversal study in which all patients who underwent a rhytidectomy using our technique from January 2002 to September 2012 were included. All patients were operated on under local anesthesia and superficial conscious sedation. All surgeries were performed by the same surgeon. A complete step-by-step description of the surgical technique can be found in the main article. Between January 2002 and September 2012, a total of 113 patients underwent facelift surgery. Of these, 88.9 % were women and 11.1 % were men. The mean age was 55.3 (± 8.66) years. Primary surgeries represented 80.3 % (n = 94), secondary 18.8 % (n = 22), and tertiary 0.85 % (n = 1). Only one major complication, representing 0.8 %, consisting of a right-sided temporal paresis with 2 months complete recovery was seen. The minor complications rate was 23.1 %. The most common minor complication was hypertrophic/keloid scars which made up 77.8 % of all minor complications. The technique described provides good and long-lasting aesthetic results with shorter scars, smaller areas of dissection (without temporal and postauricular flaps), and a shorter recovery period. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .